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Medical Policy

Laboratory Section

Policy Name Policy ID Number Date Modified

Allergy and Sensitivity Tests of Uncertain Efficacy

M-LAB01 09/01/2023
Biochemical and Cellular Markers of Alzheimer’s Disease M-LAB22 10/01/2023
Chemoresistance and Chemosensitivity Assays (CSRAs) M-LAB06 01/01/2024
COVID-19 Testing M-LAB74 11/21/2023

Laboratory and Genetic Testing for Use of Fluoropyrimidine Chemotherapy (5-FU and Capecitabine) in Patients with Cancer

M-LAB64 02/01/2024

Measurement of Salivary Hormones

M-LAB36 03/01/2024

Measurement of Serum Antibodies to Selected Biologic Agents

M-LAB65 07/01/2023
Multianalyte Assays with Algorithmic Analyses for the Evaluation and Monitoring of Patients with Chronic Liver Disease M-LAB47 01/01/2024

Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer

M-LAB60 03/01/2024
Vitamin D Testing M-LAB52 01/01/2024